Could that piece of whole wheat bread you’re eating be harming your health? Going gluten-free has been trendy for the last few years. The market for gluten-free foods is growing rapidly. People with an inflammatory condition called celiac disease must avoid all traces of gluten, a sticky group of proteins found in wheat. Gluten is actually made up of two main types of proteins called gliadins and glutenins. About 1% of the population has an immune response to these proteins, a condition called celiac disease.
Yet, even among people who test negative for celiac disease, a certain portion of the population benefits from a health standpoint by eliminating all traces of dietary gluten. This is so common that more and more mainstream health practitioners now acknowledge that you can be “sensitive” to gluten without having celiac disease. Appropriately, this condition is now referred to as non-celiac gluten sensitivity.
People who have non-celiac gluten sensitivity can experience a wide range of intestinal and non-intestinal symptoms. Estimates are that about 18 million Americans are gluten sensitive, excluding those who test positive for celiac disease. Some of the common symptoms of non-celiac gluten sensitivity include crampy abdominal pain, bloating, flatulence, and diarrhea. These are similar to the symptoms of people with celiac disease experience. However, people with non-celiac gluten sensitivity may also complain of symptoms unrelated to the intestinal tract, including joint pain or swelling, headaches, tingling in the fingers or feet, fatigue, or brain fog. Unlike celiac disease, there’s no test for gluten sensitivity.
Is It Really Gluten?
For years, people have focused on gluten as the “bad guy” for people with non-celiac gluten sensitivity, assuming that gluten is the likely cause of their distressing symptoms. Now, a new study shows that another group of proteins in wheat drives inflammation and may be a contributor or even the actual cause of non-celiac gluten sensitivity. In a new study, presented at a recent conference, researchers point out that these proteins called amylase-trypsin inhibitors, or ATIs, can trigger inflammation in the intestinal tract as well as other tissues in the body, including the lymph system, kidneys, and brain. These proteins are capable of activating immune cells and sending them into a frenzy of action, only the cells aren’t killing a foreign invader, but normal tissue. Such symptoms may explain the discomforts that people with non-celiac gluten sensitivity experience.
What’s more, researchers believe that the immune response to amylase-trypsin inhibitors may worsen or even trigger the symptoms of autoimmune conditions such as rheumatoid arthritis, multiple sclerosis, ulcerative colitis, and others. By damaging the ultra-thin lining of the small intestine (only one cell layer thick) proteins from food particles could gain access to the bloodstream, triggering an immune response, and cause inflammation in distant tissues. Plus, damage to the intestinal lining creates problems with nutrient absorption as well.
How Do Amylase-Trypsin Inhibitors and Gluten Differ?
Gluten is a general term for proteins in wheat, rye, barley, and triticale (a cross between wheat and rye). You find gluten in a wide variety of foods, including processed foods, making it very difficult to adopt a completely gluten-free diet. In contrast, amylase-trypsin inhibitors, or ATIs, are a distinct class of protein found in wheat that is unrelated to gluten. These proteins make up only about 4% of the proteins in wheat, yet they may have a significant impact on health. What makes them distinctive is they’re natural pesticides that protect wheat against insects and other invaders. As it turns out, our immune system may perceive them as foreign and launch an immune response against them. Such an immune response leads to tissue inflammation and damage and may fuel some autoimmune/inflammatory diseases.
Can You Test for Non-Celiac Gluten Sensitivity or Wheat Sensitivity?
Although you can test for wheat allergies, there isn’t a validated test for non-celiac gluten sensitivity or sensitivity to amylase-trypsin inhibitors. So, it’s not an easy task to know whether you’re sensitive to gluten or other proteins in wheat, like amylase-trypsin inhibitors. If you have any of the symptoms above, the first step is to see your doctor to rule out celiac disease. There are antibody tests for celiac disease that are fairly reliable as long as you’re eating a gluten-containing diet. If you’re not consuming gluten when you get the test, it may be falsely negative. The definitive test is an intestinal biopsy, although not everyone gets one because there is some risk involved.
Once you’ve ruled out celiac disease, see how you respond to a gluten-free diet. Take all wheat and gluten out of your diet for 3 weeks and monitor your symptoms. If your symptoms improve, you may have non-celiac gluten sensitivity, although it may no longer be an appropriate name if the real sensitivity is to amylase-trypsin inhibitors.
One caveat – non-celiac gluten sensitivity may be sensitivity to FODMAPS, carbohydrates found in foods that are not easily absorbed. FODMAPS stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. You can find lists of these foods in a variety of places online. If your symptoms are persistent, try a low FODMAP diet for a few weeks and see if your symptoms improve. Science suggests that FODMAPS can worsen certain intestinal problems, particularly irritable bowel syndrome.
The Bottom Line
It would be ideal if there were a validated test for non-celiac gluten sensitivity but there’s not. You may have to try a gluten and wheat-free diet on your own. It appears that non-celiac gluten sensitivity could be triggered by proteins in wheat other than gluten, particularly amylase-trypsin inhibitors. If you have an autoimmune condition, consider eliminating wheat from your diet to see if it makes a difference. Even better, find a health care provider who can work with you from a diet perspective rather than just prescribing medications. Autoimmune diseases are characterized by inflammation and diet can fuel inflammation. Getting your diet right is an important part of dealing with an autoimmune condition.
Keep in mind that research with regard to non-celiac gluten sensitivity is in its early stages and it’s too early to say that amylase-trypsin inhibitors are the culprit. Yet, the current studies suggest that a trial of a wheat-free diet might be worthwhile if you have an autoimmune disorder.
References:
Science Daily. “New Study Links Protein in Wheat to the Inflammation of Chronic Health Condition
BeyondCeliac.org. “What is Non-Celiac Gluten Sensitivity?”
J Exp Med. 2012 Dec 17;209(13):2395-408. doi: 10.1084/jem.20102660. Epub 2012 Dec 3.
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